Newspaper article THE JOURNAL RECORD

Commentary: Office Visit: A Highly Inflamed Conversation

Newspaper article THE JOURNAL RECORD

Commentary: Office Visit: A Highly Inflamed Conversation

Article excerpt

OK, I admit it. I am naive. I have this notion that intelligent people should be able to discuss difficult subjects thoughtfully, with all alternatives carefully weighed and thoroughly debated without personal recriminations. I must admit the debate over health reform has stretched the limits of my naivete. Every discussion concerning the tough decisions we must make over the boundaries of our medical technology has disintegrated into a furor over death squads and rationing.

We have just had another example in the recent conversations over mammography. An independent task force of the U.S. Department of Health recommended mammograms should no longer be routine for women between the ages of 40 and 49. The national clamor over this suggestion hit a fever pitch when many saw it as the first step to government rationing. Talk shows and editorials were incensed. We all know someone who has clearly benefited from this diagnostic tool. There are women alive today who were successfully treated because breast cancer was uncovered by a mammogram. So, too, there are men alive because their prostate cancer was detected by a Prostate-Specific Antigen test. However, to be outraged and to point to cases where these exams detected cancer misses the point. The point should be what makes good public policy.

Let me be clear. I am in no way questioning the legitimacy of detecting breast cancer by mammography. What I am suggesting is that we have a comprehensive and thoughtful debate around guidelines for screening tests. Here are some elements that should be included in our discussion. First, mammographies, like many screening tests, in general have a reasonably high false-positive rate. Because of this, thousands of women are diagnosed with potential breast cancers that require them to undergo either unnecessary radiation or surgery. There is a statistic that is often used by medical ethicists called Number Needed to Treat (NNT). …

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